by Peter Musser, Ph.D.
Recent headlines about the tragic and untimely death of actor Cory Monteith have, again, spurred discussion, debate and questions about addiction and the options for treating it.
I’ve treated alcoholics and addicts for the past 15 years—first in private practice and now as the clinical psychologist for a well-regarded, inpatient addiction treatment center. Those who attempt to simplify and minimize the lethality of this problem-—which the AMA first recognized as a disease in 1956—are doing a disservice to millions of American addicts and their families. What we don’t usually see in the headlines are the many addicts who have found recovery, are living successful, healthy lives without drugs or alcohol, and the important combination of treatment approaches that often yield these results.
One exception is Matthew Perry’s recent cover of People Magazine. Perry, by his own account, was in a death spiral because of addiction. He received professional, medical, psychological and spiritual treatment. He finds support in recovery fellowships that help him maintain his wellness. Despite telling his story on the cover of People and the fact that there are millions more like him, there isn’t a groundswell of support for the comprehensive treatment he received. Why is that? Unlike diabetes and heart disease, addiction resides in the organ with which we make choices: the brain. Because it is a brain disease, much like other mental illnesses, it is perhaps difficult for those not afflicted to understand and accept the totality of the compulsion to use substances to a degree that is life-threatening and often life-ending.
Advanced neuroimaging techniques show us that the brains of alcoholics and addicts react differently when exposed to drugs or alcohol compared to those of nonaddicts. What this means is that not only does the addict’s brain need to be treated medically with careful detox, but there must also be therapeutic support through the post-acute withdrawal period. Therapy and peer support help the individual begin to understand what is occurring in the brain and the strategies he or she can employ to minimize the risk of relapse. We’ve found that using cognitive behavioral therapy, motivational interviewing and special therapeutic approaches that address prior traumas and the lasting chemical “footprint” those traumas leave on the brain, can increase the likelihood of patients living a full, healthy life.
Those who would suggest that solid, professional addiction treatment is the “reason” for an addict’s death do not understand the complexities of this disease. Do we blame the cardiologist when someone with a diagnosed cardiac condition ignores recommendations for diet, exercise and supportive medication and dies of a cardiac event? Or, do we acknowledge that the disease is more complex than simply the physical symptoms and suggest a more comprehensive treatment approach that includes behavioral approaches that improve the patient’s chances of compliance with the treatment recommendations? Would we encourage someone with heart disease to avoid seeing a cardiologist for treatment because some with heart disease have succumbed after seeking or receiving treatment? I think we’d help them find competent treatment. Individuals struggling with addiction, and their families, need to know that professional, multidisciplinary treatment works, that those who engage in ongoing programs of support are most the successful in avoiding relapse, and that treatment may need to be repeated, or revised, especially following major stresses or traumas.
Of the patients I see at our nonprofit facility, 90% have a prior trauma, a co-occurring psychiatric disorder or a co-occurring compulsion or process addiction such as gambling, sex obsession, eating disorder, etc. Unless each of these conditions is addressed and treated as part of their addiction treatment, the patient has a high likelihood of relapse and, potentially, death. This type of comprehensive assessment and treatment requires a skilled team of professionals and many of the best treatment centers offer this complete approach. (See the questions below about how to assess a solid treatment program.)
According to the Centers for Disease Control and Prevention (CDC), prescription drug deaths are now the leading cause of accidental death in the U.S. and prescription drug deaths outnumber death by homicide or motor vehicle accidents. It is also becoming commonly accepted among clinicians that the new “gateway drugs” are the prescribed, extremely addictive, opioid pain medications.
Instead of arguing over whether addiction treatment leads to death, we should focus on the addiction epidemic itself and how to prevent it.
What can be done? Be vigilant with your own health and your children’s. Avoid addictive prescription drugs in the first place. Ask if there is a nonopiate alternative. Avoid first use of addictive drugs or alcohol for your children until their brains have fully matured. If you have an acute medical condition or procedure that requires the use of opiates, request you be given the absolute fewest necessary. Never keep drugs that are left over. That’s how our teenagers and others get them. We can all be part of the solution to minimize illicit use and availability of these drugs on the streets and in our homes.
Seventy percent of the time, those using these medications illicitly have stolen or obtained them from a family member. The recent escalation of heroin deaths is associated with individuals who have been using prescription opiates and then turn to heroin when they can’t get prescription drugs, or when they have become cost-prohibitive. I have middle-class patients in my office each week who describe the horror of being prescribed an opiate, becoming addicted and turning to using heroin—sometimes within just a few months.
If you or someone you love is addicted, seek help. Here are some questions to ask to find a reputable treatment center than can help start someone on the road to recovery:
How long has the center been treating addiction? (should be more than 15 years)
Is the center Joint Commission accredited? http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx
Is the center for-profit or nonprofit? The top centers in this country are nonprofit
Is there a full-time psychiatrist? Are all the clinicians licensed? Is there a full-time medical physician available 24/7?
Is there a doctorate-level psychologist or someone trained in the co-occurrence of trauma and addiction on staff? (Very often substances have become the only way of coping with past traumas, and these must be addressed before someone can pursue healthy early recovery.)
Do they offer medically-managed detoxification and support a goal of abstinence?
Do they offer bio/psycho/social/spiritual assessment, education and treatment modalities?
Drug addiction has reached epidemic status. Some of today’s addicts are, sadly, chronic pain patients for whom opiates were prescribed in ever-increasing doses by a physician. Even those dependent on opiates or benzodiazepines prescribed for chronic pain can benefit from multi-disciplinary, comprehensive addiction treatment and go on to lead productive lives without dependence on addictive substances.
Dr. Peter Musser, Ph.D. is Clinical Psychologist for the Father Martin’s Ashley nonprofit, drug and alcohol treatment center in Havre de Grace, Maryland, and is in private practice in Eldersburg, Maryland. He holds a Ph.D. in human services psychology from University of Maryland Baltimore County and an M.A. in general psychology with an emphasis in research methods. Dr. Musser is a member of the American Psychological Association, Maryland Psychological Association, American Counseling Association and the former faculty at McDaniel College. He can be reached at firstname.lastname@example.org